A report of 2 patients with transient blindness following Le Fort I osteotomy and a review of past reported cases

Abstract

Blindness following a LeFort I osteotomy is a rare but extremely serious complication. Ten cases have been reported to date. None of these patients recovered vision. Optic neuropathy is believed to be the cause but the exact mechanism has not been settled. We report the first, and the only two, documented cases of complete loss of vision that recovered subsequently. The first patient was a 19-year-old male with repaired bilateral cleft lip and palate. He developed loss of vision in the right eye on the second postoperative day. The second patient was a 22-year-old male with repaired unilateral cleft lip and palate. He developed complete loss of vision in the left eye on the day of surgery. Both these patients underwent ongoing studies, which did not show any abnormalities. Both were treated with methylprednisolone. Both the patients gradually showed improvement in their vision. The first patient recovered normal vision several months postoperatively. The second patient's vision improved to 4/60 by 4 months postoperatively. We discuss the probable mechanisms of optic nerve injury and also the possible reasons why sight was restored in these patients. This is a rare but serious complication following a fairly common procedure. Through this article we wish to create an awareness of this complication and also a possible way of avoiding such a disaster.

Factors Affecting Optic Nerve Damage in Le Fort III Osteotomy: A Retrospective Study

“…However, inflammatory changes at the apex of the orbit during osteotomy of the pterygomaxillary junction could have been responsible for optic nerve damage. 3,5,6 The general treatment modality was steroid pulse therapy, which has shown efficacy in certain cases. 9 Another cause of blindness is optic nerve damage due to strong traction on the optic nerve.…”

“…The underlying cause was not investigated in 11 of these patients. However, inflammatory changes at the apex of the orbit during osteotomy of the pterygomaxillary junction could have been responsible for optic nerve damage 3,5,6. The general treatment modality was steroid pulse therapy, which has shown efficacy in certain cases 9…”

“…F ew reports have examined blindness and visual impairment following Le Fort osteotomies for syndromic craniosynostosis. [1][2][3][4][5][6][7][8][9] Blindness, following its occurrence, places a major burden on quality of life; therefore, this impairment is considered a serious complication. Of the 12 reports of blindness and visual impairment following Le Fort osteotomy, an obvious cause was identified in 3 cases; however, the cause was unknown or not described in the 9 other cases.…”

“…In the 9 other cases, damage to the optic nerve was hypothesized to have been caused by ischemia or nerve infarction due to brain hypoperfusion, which may have resulted in ischemic optic neuropathy or retinal artery occlusion. 1,2,[6][7][8] In the field of anesthesiology, the association between massive bleeding and optic nerve damage has been reported previously; however, the association of blood transfusion volume and operating time with this complication have not been clarified and no reports have followed up specific clinical data. 10,11 This study investigated potential causes of optic nerve damage with particular attention to intraoperative blood transfusion volume and operating time, as well as methods that may promote its prevention.…”

“…Few reports have examined blindness and visual impairment following Le Fort osteotomies for syndromic craniosynostosis 1–9. Blindness, following its occurrence, places a major burden on quality of life; therefore, this impairment is considered a serious complication.…”